Gallery Night Registration Form

Name*

First Last

Name of purchaser (if different from above)

First Last

Gallery Name (to be listed in program)*

Gallery address to be listed in program*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

email*

Phone*

Select Member or Non-Member*

Pick Gallery Night you want to register for*

Name of Exhibit*

Exhibiting Artists Name*

Medium of Art (ex. watercolor, collage...)*

Complimentary refreshments provided?*

Refreshments are:

Live entertainment provided?*

Live entertainment is:

Any demonstrations?*

Demonstrations are:

Artist meet and greet?*

Brief event description: Is anything else going on that you would like to mention?

Would you like printed Gallery Night brochures?*

How many brochures would you like?*

Provide link to your website/FB page for social media purposes.*

I understand the Erie Art Museum may edit this information to maintain uniformity in text and style.*

Phone

This field is for validation purposes and should be left unchanged.